Special Visual Based Supplement (Rheumatology)

Section 1

Q. 1 Supplement

Question Id: 5454457 Question Type: Subjective Max Marks : 0

Solution:
1.Polyarteritis nadosa

2.Reiter's Disease 3
3.Reiter's Disease 1

4.Reiter's Disease 2

5.Pseudogout

6.SLE-1
7.SEL-2

8.Swan neck heart block

9.Marfan syndrome 1

10Marfan syndrome 2
11.Kerotoderma blenorrhagica

12.Kawasaki disease

13.Hammer toe deformity 2

14.Hammer toe deformity 1

15Giant cell arteritis

16Circinata Balanitis

17. Thenar wasting due to carpal tunnel syndrome. This is often associated with osteoarthritis: note nodal change on the terminal interphalangeal joints of the index fingers.
18. Symmetrical joint involvement due to rheumatoid arthritis.

19. Vasculitis. Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis. (Vasculitis)

20. Purpura in Henoch-Schonlein disease.

21. Rash of systemic vasculitis (palpable purpura). (Vasculitis)

22. Charcot neuroarthropathy (RA)

23 Daylight sign, due to metatarsophalangeal joint synovitis in rheumatoid arthritis.

24. (a) Early rheumatoid arthritis: local osteopenia, loss of joint spaces, soft tissue swelling. (b) Late rheumatoid arthritis: erosion of periarticular surfaces and ulnar
sublaxation.
25. The hand in rheumatoid arthritis. (RA)
A. Ulnar deviation of the fingers with wasting of the small muscles of the hands and synovial swelling at the wrists, the extensor tendon sheaths, the metacarpophalangeal
and proximal interphalangeal joints.
B. 'Swan neck' deformity of the fingers.

26. Rheumatoid (necrobiotic) nodules. Thoracic CT just below the level of the main carina showing the typical appearance of peripheral, pleural-based nodules. The
nodule in the left lower lobe shows characteristic cavitation. (RA)

27. Rheumatoid nodule overlying the olecranon of the right arm

28. Nailfold vasculitis in rheumatoid arthritis. This also occurs in SLE and polyarteritis nodosa.

29. Swan-neck deformity of the right hand. Note also wasting of the small muscles of the hand owing to disuse in this patient with rheumatoid arthritis.

30. Compensated polarised light microscopy of synovial fluids (× 400). (Gout)

A.Monosodium urate crystals showing bright birefringence (negative sign) and needle-shaped morphology.
B.Calcium pyrophosphate crystals showing weak birefringence (positive sign), scant numbers and a predominantly rhomboid morphology. These are clearly more difficult
to detect than urate crystals
31. Gouty tophi of the index finger.

32 Podagra. Acute gout causing swelling, erythema and extreme pain and tenderness of the first metatarsophalangeal joint.(Gout)

33. Tophus with white MSUM crystals visible beneath the skin. Diuretic-induced gout in a patient with pre-existing nodal OA. (Gout)
34. Nodal osteoarthritis. Heberden's nodes and lateral (radial/ulnar) deviation of distal interphalangeal joints, with mild Bouchard's nodes at the proximal interphalangeal
joints. (OA)

35. Typical varus deformity resulting from marked medial tibio-femoral osteoarthritis (OA)
36. Nodal osteoarthritis (Heberden's nodes).

37. 'Bamboo' spine of severe late ankylosing spondylitis. Note the symmetrical marginal syndesmophytes (arrows), sacroiliac joint fusion and generalised osteopenia
(AS)

38. Radiographic syndesmophyte (arrows). (AS)

A. Fine symmetrical marginal syndesmophytes typical of ankylosing spondylitis.
B. Coarse, asymmetrical non-marginal syndesmophytes typical of psoriatic/Reiter's spondylitis.
39. Psoriatic arthropathy. (AS)
A. 'Sausage' middle finger of a patient with psoriatic arthritis.
B. Typical distal interphalangeal joint pattern with accompanying nail dystrophy (pitting and onycholysis).

40. Butterfly (malar) rash of systemic lupus erythematosus, sparing the nasolabial folds. (SLE)
41 Typical facial appearance in the CREST syndrome (PSS)

42. Systemic sclerosis. Hands showing tight shiny skin, sclerodactyly, flexion contractures of the fingers and thickening of the left middle finger extensor tendon sheath
(PSS)

43. Oral ulceration in Behcet's syndrome. (Behcet)

44. Typical eyelid appearance in dermatomyositis. Note the oedema and telangiectasia. (dermatomyositis.)

45 Hyperextensibility of the digits in Ehlers-Danlos syndrome.